Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery

In this case series and review, we highlight 2 adult congenital cases, diagnosed with anomalous origin of the right coronary artery (RCA) from the pulmonary artery (PA). Patient 1 is a 57-year-old woman who presented to the cardiology clinic for episodes of palpitations and dizziness associated with dyspnea on minimal exertion. Ambulatory electrocardiograph monitoring revealed brief runs of nonsustained ventricular tachycardia and supraventricular tachycardia up to 3 minutes. Cardiac computed tomography angiography revealed anomalous origin of the RCA from the main PA. Nuclear Regadenoson stress test demonstrated anterior wall/anterolateral wall peri-infarctional ischemia. She underwent successful surgical repair with coronary reimplantation. Patient 2 is a 61-year-old man who presented to the emergency department for shortness of breath and alcohol intoxication. Computed tomography angiography of the chest/abdomen/pelvis was performed in the emergency department that was suspicious for anomalous RCA. Left heart catheterization revealed large RCA, with anomalous origin from the PA.